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But Doctor, It’s YOUR Responsibility

Whose responsibility is it to educate the patient about using their health insurance? If the patient goes to the pharmacy and is quoted an absurdly high price, doesn’t know about alternatives, and the pharmacy doesn’t advise them, should I have anticipated that?

What if the patient gets hosed after being recommended a shitty DME company for their sleep apnea device, finding out a few months later that they got billed way too much. My fault? He is my patient, after all.

Where does my responsibility begin, and where does it end? What about the patient? Regulators? Commercial insurance? The state where the patient is insured?

Health Insurance is Mandatory

One could argue that if the government forces you to have certain insurance, such as auto or health, it’s on them to make your rights obvious to you. That isn’t always the case.

But if you buy auto or health insurance, it’s a good idea to know your rights. Had your surgery been denied? Did you write an appeal letter to the insurance company?

You went to the pharmacy, and they said your medication would cost $300. Who do you blame? “Oh, doctor, you should have known better and not prescribed that to me.”

Who is Responsible

Patient education is my job, but honestly, I don’t know much about health insurance and don’t have my broker license. I really couldn’t tell you whether your HealthNet covers a particular drug at a particular dose. Molina, you say? HMO or PPO? Sorry, don’t know their drug formulary either.

A recent LI post uncovered some important sentiments. Namely, Dr. Mo is responsible for educating his patients on which drugs are not affordable and anticipating pharmacy prices.

I’m happy to discuss whether you need an MRI and provide any information your insurance company might need, but I cannot help you navigate your insurance.

It’s not that I don’t want to; I have no clue. There are specific people who do this for a living, from patient advocates to insurance navigators to benefit managers.

Just as they cannot guide you on the ideal antibiotic regimen for your diverticulitis attack, I can’t really figure out your out-of-pocket max and plan the rest of your annual spending.

Health Illiteracy

What is health literacy? It’s understanding how to navigate your health. This involves navigating and understanding your health insurance, communicating with your doctor, vetting information shared with you, and gaining empowerment.

I would love it if our public health policy strongly emphasized health literacy. I think we already do a really good job, but the marketing budget of the guy who tells you to eat raw liver is bigger than my local DHS.

Health illiteracy isn’t an insult; it’s a condition many Americans face as they try to navigate their health. Health literacy decreases as healthcare becomes more complex and more diagnoses and treatments appear.

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